1982911848 NPI number — JASON JAE SIM ASW

Table of content: JASON JAE SIM ASW (NPI 1982911848)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982911848 NPI number — JASON JAE SIM ASW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIM
Provider First Name:
JASON
Provider Middle Name:
JAE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ASW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982911848
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BRIAN D. ALLGOOD ARMY COMMUNITY HOSPITAL (BDAACH) UNIT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AP
Provider Business Mailing Address Postal Code:
96271
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-737-4236
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BRIAN D. ALLGOOD ARMY COMMUNITY HOSPITAL (BDAACH)
Provider Second Line Business Practice Location Address:
UNIT 15245
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AP
Provider Business Practice Location Address Postal Code:
96271
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-737-4236
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/13/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LCSW79533 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 104100000X , with the licence number: ASW 33337 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 172V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)